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Time to Transform our Health and Human Service System July 22, 2011

Posted by tomwolff in : Uncategorized , trackback

The time has come for us to rethink and transform the health and human services system in this country. These services cover a vast array of organizations providing a very broad range of services and consume large parts of federal, state and local budgets. The services are often critical for the consumers but the core premises on which the system is based and the system of delivery itself is highly dysfunctional.

The delivery system is characterized by:

1)      A focus on individuals not communities and ignores the environment in which the individual lives

2)      Focuses on the deficits of the individual and the community not their strengths and assets

3)      Services remain targeted at crises and remedial services ignoring how prevention could prevent the problem from occurring in the first place by catching issues upstream

4)      Our systems fail to respond to the diversity of our communities much less address issues of structural oppression, racism etc.

5)      Our helping systems excessively rely on professionals and fail to acknowledge and engage the natural helping systems of families and neighborhoods. Increasingly our helping systems have become detached from the communities they serve.

6)       Our helping system fails to engage those most affected by the issue as equal partners in planning, delivering and evaluating their interventions.

7)      As a system the health and human services in any given community tends to be: competitive rather than collaborative; fragmented so that individuals are treated for distinct problems rather than as whole beings; efforts are duplicated due to lack of information rather than coordinated

8)      Finally the helping system and many of those working in the system have lost their spiritual purpose. They may have chosen their fields with hopes of addressing the common good and now end up counting billable hours.

These system dysfunctions are discussed at greater length in my book The Power of Collaborative Solutions www.tomwolff.com

I have been preaching these dysfunctions and their solutions for decades so it was  a delight to find a fellow traveler and another community psychologist on this campaign in Isaac Prilleltensky , the Dean of  the School of Education at the University of Miami.

Isaac contrasts systems that he describes as SPEC vs DRAIN with SPEC systems standing for systems based on  Strength, Prevention, Empowering and Community. While DRAIN stands for Deficit, Reactive, Arrogant, Individual.

More details on Isaac’s system are available at their web site: http://www.specway.org/wiki/collaboration

Many of us have some stories of individual systems, agencies or interventions that have been able to move from SPEC vs DRAIN (see community stories in my book, or previous issues of my Collaborative Solutions Newsletters  www.tomwolff.com ). These stories need more public airing.

However, the urgent questions now facing all of us are how do we transform our dysfunctional helping system to a strength based system that addresses the system shortcomings noted above and moves in new positive directions.

The present fiscal crisis is leading to dramatic cuts of funding to this helping sector but as noted in my last newsletter (Thriving and Surviving in Hard Times) this is not leading to system transformation but rather retrenchment to a more dysfunctional system. We are cutting prevention and keeping remediation, cutting community wide healthy community programs and keeping services for individuals, etc.

I’d love to hear your thoughts on how to convert our dysfunctional helping systems to ones that are focused on communities, prevention, strengths, our community’s diversity, build on community helping systems, bring those most affected by the issues to the table as equal partners, operate collaboratively, and engage our spirituality as the compass for social change. What are your ideas for transformation of our nation’s health and human service systems.

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1. Scot Evans - July 29, 2011

Tom, thanks for this post. Like you, I see current Human Service practice as an impediment, not a solution to, many of the complex issues individuals and communities face. As I see it, we have a system that, for many reasons, is experiencing “paradigm paralysis”: a way of doing things in that has become so ingrained in the culture that it limits the perspective of what human service could be (Proehl, 2001).

Our SPEC model and approach to working with organizations was our way of offering up an alternative framework for practice. More importantly I believe, is that the process of engaging organizations around a values-based framework such as SPEC gets people THINKING about and REFLECTING on their practice, rather than working on habitual auto-pilot.

That’s what I’ve been thinking and writing about lately as I continue working with community orgs. I think we have an obligation to nudge human service organizations and their funders to engage in critical practice that problematizes the dysfunctional characteristics you list above. Too often, I believe, we get co-opted into helping human service orgs find and implement what Schon calls technical-rational solutions that fall short of making any real impact – and may in fact make things worse.

Stay tuned for more from me on this…~Scot

2. Tom Wolff - August 1, 2011

Thanks for your comments Scot
I am in total agreement that we need to move the helping system in the directions you describe as SPEC and I describe in my blog
However the question is how we move the helping system to get there. i have been at this for over 35 years and I now believe that the top rpiority is to get government and funders to change their expectations in the direction of SPEC. I think we have to go beyond nudging or we’ll never get there. The helping system is deeply invested in remedial individual approaches. Getting a single agency to think, reflect and even change is something I have done often in my career but the agency then faces a community of providers and funders who not only do not understand what they do but can be hostile to the new way of proceeding. So I agree we have to help individual agencies change
BUT we ALSO must help change the whole system of funding. The recent national push for prevention in the new health care bill is an example (http://healthyamericans.org/assets/files/NPS%20Framework.pdf) Also I recently saw SMAHSA’s (Substance Abuse Mental Health Service Admin.)new priorities and prevention is at the top of the list as well.
These system change can only help our cause.
Glad to know we are in this together.